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J Appl Physiol 97: 98-108, 2004. First published February 27, 2004; doi:10.1152/japplphysiol.00462.2003
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Developmental changes in upper airway dynamics

Carole L. Marcus,1 Lucila B. Fernandes Do Prado,2 Janita Lutz,1 Eliot S. Katz,1 Cheryl A. Black,1 Patricia Galster,1 and Kathryn A. Carson3

1The Eudowood Division of Pediatric Respiratory Sciences and the 3Division of Oncology Biostatistics, Johns Hopkins University, Baltimore, Maryland 21287-2533; and 2Department of Neurology and Internal Medicine, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, Brazil

Submitted 2 May 2003 ; accepted in final form 17 February 2004

Normal children have a less collapsible upper airway in response to subatmospheric pressure administration (PNEG) during sleep than normal adults do, and this upper airway response appears to be modulated by the central ventilatory drive. Children have a greater ventilatory drive than adults. We, therefore, hypothesized that children have increased neuromotor activation of their pharyngeal airway during sleep compared with adults. As infants have few obstructive apneas during sleep, we hypothesized that infants would have an upper airway that was resistant to collapse. We, therefore, compared the upper airway pressure-flow () relationship during sleep between normal infants, prepubertal children, and adults. We evaluated the upper airway response to 1) intermittent, acute PNEG (infants, children, and adults), and 2) hypercapnia (children and adults). We found that adults had a more collapsible upper airway during sleep than either infants or children. The children exhibited a vigorous response to both PNEG and hypercapnia during sleep (P < 0.01), whereas adults had no significant change. Infants had an airway that was resistant to collapse and showed a very rapid response to PNEG. We conclude that the upper airway is resistant to collapse during sleep in infants and children. Normal children have preservation of upper airway responses to PNEG and hypercapnia during sleep, whereas responses are diminished in adults. Infants appear to have a different pattern of upper airway activation than older children. We speculate that the pharyngeal airway responses present in normal children are a compensatory response for a relatively narrow upper airway.

sleep-disordered breathing; critical pressure; infants; children; upper airway collapsibility


Address for reprint requests and other correspondence: C. L. Marcus, Div. of Pediatric Pulmonology, Wood Bldg., 5th floor, Children's Hospital of Philadelphia, 34th St. & Civic Center Blvd., Philadelphia, PA 19104 (E-mail: marcus{at}email.chop.edu).




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